Clinical Reasoning in the Use of Long-acting Aripiprazole in Psychosis in Bilateral Nephrectomy on Hemodialysis
Karim Abdel Aziz1, Aysha Alhashmi2, Omar Bin Abdul Aziz2, Khalid Jawabri2, Hind Mohd Ahmed2, Alyazia Alkaabi2, Emmanuel Stip1,3,4
1Department of Psychiatry, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
2Behavioural Science Institute, Al-Ain Hospital, Al-Ain, United Arab Emirates
3Department of Psychiatry, University of Montréal, Montréal, Canada
4Institut Universitaire en Santé Mentale de Montréal Université de Montréal, Montreal, Canada
Correspondence to: Karim Abdel Aziz
Department of Psychiatry, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
E-mail: kabdelaziz@uaeu.ac.ae
ORCID: https://orcid.org/0000-0002-7609-7756
Received: February 15, 2024; Revised: March 8, 2024; Accepted: March 12, 2024; Published online: April 29, 2024.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Psychiatric disorders are common in patients on hemodialysis. To the best of our knowledge there are no reported cases of psychosis developing in hemodialysis patients in the context of nephrectomy, and there is limited data on the use of long-acting antipsychotics in hemodialysis, which are generally not recommended in chronic kidney disease. We present the case of a 40-year-old lady with bilateral nephrectomy receiving hemodialysis who developed psychosis that resulted in her refusing to continue hemodialysis and was irregularly compliant with oral antipsychotics, necessitating the use of a long-acting injection. We report on the approach to clinical reasoning in the choice of aripiprazole and the need for a long-acting injection. Based on its pharmacological and pharmacokinetic properties oral aripiprazole 20 mg was commenced and after establishing tolerability and response, the patient was switched to long-acting aripiprazole 400 mg monthly achieving full remission of psychotic symptoms after 6 months with maintained improvement after 12 months. Based on its properties, aripiprazole may be a reasonable option in the treatment of psychosis in patients on hemodialysis with nephrectomy and can be considered even as a long-acting injection in these patients.
Keywords: Psychotic disorders; Renal dialysis; Nephrectomy; Antipsychotic agents; Aripiprazole; Long-acting

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